Tonsillectomy Part 2 - Tonsillectomy Techniques - Hot & Cold Methods

🩺 Tonsillectomy – Techniques and Methods

In the previous post, we discussed what is tonsillectomy along with its indications and contraindications.

In this post, we will focus on the different techniques and methods of tonsillectomy, which is a very commonly asked topic in ENT exams and vivas.

🔹 Classification of Tonsillectomy Techniques

Tonsillectomy techniques are broadly classified into:

1. Cold methods

2. Hot methods

👉 Hot methods are those in which temperature is used as a mode of dissection.

❄️ Cold Methods of Tonsillectomy

1️⃣ Dissection and Snare Method

• Most commonly used method

• Standard and widely practiced

What are the steps of Tonsillectomy by Dissection & Snare method?

2️⃣ Guillotine Method

• Obsolete method

• Rarely used in modern practice

3️⃣ Intracapsular (Capsule Preserving) Tonsillectomy – Microdebrider

• Uses a 45° angled microdebrider

• Speed: 1500 RPM

✅ Advantages

• Less post-operative pain

• Faster return to normal diet

❌ Disadvantage

• Increased intra-operative bleeding

4️⃣ Harmonic Scalpel (Ultrasound)

• Uses ultrasonic technology to cut and coagulate tissue

• Electrical energy is converted into mechanical vibration

What is the frequency and Vibration amplitude used in Harmonic scalpel Tonsillectomy?

What are the advantages of using Harmonic scalpel as a technique in Tonsillectomy?

5️⃣ Coblation (Plasma Mediated Ablation)

• One of the most popular modern techniques

• Uses radiofrequency bipolar current

• Current passes through normal saline

• Produces a plasma field of energized sodium ions

🛠️ Instrument

• Coblator handpiece with:
  • Electrode
  • Irrigation channel
  • Suction channel

What is the mechanism by which Coblation works?

What are the advantages of using Coblation as a technique in Tonsillectomy?

6️⃣ Cryosurgery

• Uses liquid nitrogen

• Temperature: –196°C

• Pressure: 22 psi

🔬 Technique

• Cryoprobe applied to tonsil

• Two freeze–thaw cycles

• Each application: 3–4 minutes

🔍 Outcome

• Tonsillar tissue undergoes necrosis

• Tissue sloughs off later

• Leaves a granulating surface

✅ Advantage

• Minimal bleeding due to vascular thrombosis

🔥 Hot Methods of Tonsillectomy

Hot methods use temperature as the primary mode of dissection.

1️⃣ Electrocautery

✅ Advantages

• Reduced intra-operative blood loss

• Shorter operating time

❌ Disadvantages

• Increased post-operative pain

• Higher secondary hemorrhage risk

• Delayed healing

2️⃣ Laser Tonsillectomy

• Uses:

  • CO₂ laser
  • KTP laser (most preferred)

3️⃣ Radiofrequency Tonsillectomy

• Uses radiofrequency waves at 460 kHz

• Employs a bipolar electrode

• Electrode contains a temperature sensor

✅ Advantages

• Precise control of:

  • Tissue temperature
  • Energy delivery

📌 Final Tonsillectomy Methods Classification Recap

📌 Key Exam Pearls

• Dissection & snare = most commonly used

• Coblation = least postoperative pain

• Electrocautery = faster surgery, more pain

• Coblation works at ~60°C

• Cryosurgery uses –196°C liquid nitrogen

📚 Next Topic:
Hot tonsillectomy vs Interval tonsillectomy

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